Rosh Emergency Medicine Practice Test

What is the appropriate course of action for a patient with elevated serum creatinine likely due to benign prostatic hyperplasia?

1. A. Start diuretics

2. B. Immediate catheterization

3. C. Monitor and repeat tests

4. D. Start surgical consultation

The correct answer is: B. Immediate catheterization

In the scenario presented, the appropriate course of action for a patient with elevated serum creatinine most likely due to benign prostatic hyperplasia (BPH) is to perform immediate catheterization. BPH can lead to urinary retention, which may cause an increase in serum creatinine due to the kidneys being unable to adequately clear waste due to impaired urinary flow. Catheterization can relieve urinary retention by draining the bladder, thus potentially improving renal function and lowering serum creatinine levels. Immediate catheterization addresses the underlying issue of urinary obstruction caused by BPH, allowing for the restoration of normal urinary flow and preventing further renal impairment. This approach is often necessary in acute situations where there is evidence of significant retention leading to renal dysfunction. While monitoring and repeating tests could be a reasonable subsequent step after addressing the immediate concern, it does not provide the immediate intervention required to alleviate urinary obstruction. Starting diuretics is not indicated in the context of an obstruction, as they can exacerbate the problem by increasing urine output without resolving the blockage. Finally, surgical consultation may be appropriate in the long-term management of BPH but it is not the immediate or most necessary action in response to acute renal impairment secondary to urinary retention.